Working remotely on software quality assurance, system testing and user testing.Vast experience in preparing test plans and use cases.Significant attention to details.Any system; mobile and web-based.

Provided analytical reports of health insurance claims and providers to show trends as well as root cause of system failures.Proficient in creating Business Requirement Documents that clearly explain current system procedures and suggest solutions for improvements.Created Data Warehouse queries and reports, using SQL, SAS and Cognos, to analyze correlations between age, gender, diagnosis and treatment procedures.Keywords: Healthcare, insurance, claims, adjudication, Data analysis, Business analysis, SQL, SAS, Cognos, Data Warehouse

Provided data analysis, requirements and business analysis, as well as project management for the Claims Department.Developed integrated project plans including resource allocation for multiple concurrent projects;Facilitated & coordinated Quality Assurance and User Acceptance testing based on Enterprise Project Management Office (EPMO) methodologies.Main achievements include: • Plan, analyze, design and manage the successful implementation of an automated interface from the central claims processing system to the Corporate General Ledger. This 6-months effort followed a two-year failed attempt by others to build this interface.Project included defining accounting requirements for Claims Expense, analyzing reconciliation procedures and solution design.• Analyze and re-design claims adjudication workflow to route selected Diagnosis Related Grouping (DRG) facility claims for special handling; produce a Business Requirements Document (BRD) and manage the implementation• Analyze and re-design Explanation-of-benefits (EOB) production process to include Fair Hearing Forms with denied claims, to comply with State regulations.• Automate the adjudication process of Home Health Care claims. Devised formulas to bridge provider billed hours with member benefits defined in number of visits. Successfully conducted thorough business analysis and managed the entire project life cycle.• Develop SQL query templates for recurring Data Warehouse report requests, joining tables to show member-claim-provider data on the same report.Keywords: Healthcare, insurance, claims, adjudication, Medicare, Medicaid, QCare, Home Health Care, business analysis, data analysis, project management, Cognos, SAS, SQL

Managed IT projects to develop printing and fulfillment solutions for Health Insurance and Financial companies.

Managed the requirement definition and implementation of a Remote Capture system for deposits.Responsible for business requirements, vendor selection, User Acceptance Test, User Training, User Documentation and final implementation.

• Analyzed complex business requirements, transaction workflows and interaction between Sales and Customer Relations Management (CRM) systems• Heavily involved in entire software systems development lifecycle (SDLC)• Created Functional Specifications and Use Case documents for web-based and back office systems.• Lead the approval process for these analysis and design documents vis-à-vis user representatives and IT development teams• Interfaced with development teams throughout system development phase• Planned and performed system testing and QA